POS0121 ASSOCIATION OF LUPUS LOW DISEASE ACTIVITY STATE ATTAINMENT WITH REDUCED ORGAN DAMAGE AND FLARE IN SLE PATIENTS WITH HIGH DISEASE ACTIVITY
Authors: R. Kandane-Rathnayake, V. Golder, W. Louthrenoo, Y.H. Chen, J. Cho, A. Lateef, L. Hamijoyo, S.F. Luo, Y.J. Jan Wu, S. Navarra, L. Zamora, Z. Li, Y. An, S. Sockalingam, Y. Katsumata, M. Harigai, Y. Hao, Z. Zhang, B. Basnayake, M. Chan, J. Kikuchi, T. Takeuchi, S.C. Bae, S. Oon, S. O'neill, F. Goldblatt, K. Gibson, K. Ng, A. Law, N. Tugnet, S. Kumar, C. Tee, M. Tee, Y. Tanaka, C.S. Lau, M. Nikpour, E.F. Morand, A. Hoi
Journal: Annals of the Rheumatic Diseases (2022)

<h3>Background</h3> In SLE patients, episodes of high disease activity state (HDAS, SLEDAI-2K≥10) are associated with worse outcomes even if only experienced once. We investigated whether attainment of the lupus low disease activity state (LLDAS) was associated with protection against adverse outcomes in SLE patients after an episode of HDAS. <h3>Objectives</h3> To compare LLDAS attainment between HDAS and non-HDAS patients. <h3>Methods</h3> Data on 4,106 SLE patients from a multinational cohort, collected prospectively between 2013 and 2020, were analysed. Disease activity was assessed using SLEDAI-2K. Patients who had SLEDAI-2K≥10 at least once were defined as HDAS patients. For the purpose of evaluating long term outcomes, each HDAS patient's first visit with SLEDAI-2K≥10 was assigned as baseline, and for non-HDAS patients, recruitment was considered as baseline. Patients in LLDAS continuously for ≥6 months were defined as in sustained LLDAS (≥6months- and ≥12months-sustained LLDAS). Survival analyses were performed to examine the association between LLDAS attainment and damage accrual and flare. <h3>Results</h3> 1076 patients (26%) had HDAS at least once (HDAS-ever). Compared to patients who never experienced HDAS (HDAS-never), HDAS-ever patients were younger, had shorter disease duration at enrolment, and a longer study follow-up period. HDAS-ever patients had higher disease activity across the observation period measured by time-adjusted mean SLEDAI-2K and PGA; higher PNL and IS use, more flares, organ damage, and damage accrual. None of the HDAS cohort and 42% of HDAS-never group were in LLDAS at baseline (HDAS-never/not LLDAS BL). 66% of HDAS-ever and 57% of 'HDAS-never/not LLDAS BL' patients attained LLDAS at least once during the study observation period. Proportions of patients in sustained LLDAS and who had cumulative LLDAS ≥ 50% of observed time (LLDAS-50) were lower in HDAS-ever patients (Table 1). LLDAS-50 attainment was protective from damage accrual and flare in both HDAS-ever and HDAS-never patients (Table 1). Sustained LLDAS was similarly protective from damage accrual and flare in both 'HDAS-ever' and 'HDAS-never/not LLDAS BL' groups (Table 1). <h3>Conclusion</h3> Sustained or majority LLDAS was less achievable in SLE patients after an episode of HDAS in HDAS-ever compared to HDAS-never patients, but protective associations of LLDAS against organ damage accrual and flare were similar regardless of HDAS. LLDAS attainment is protective from adverse outcomes even after high disease activity. <h3>Acknowledgements</h3> We thank all patients participating in the Asia Pacific Lupus Collaboration (APLC) cohort, and all data collectors for their ongoing support for APLC research activities. The APLC has received unrestricted project grants from AstraZeneca, BMS, Eli Lily, Janssen, Merck Serono, and UCB to support data collection contributing to this work. <h3>Disclosure of Interests</h3> Rangi Kandane-Rathnayake: None declared, Vera Golder: None declared, Worawit Louthrenoo: None declared, Yi-Hsing Chen Speakers bureau: Pfizer, Novartis, Abbvie, Johnson &amp; Johnson, BMS, Roche, Lilly, GSK, Astra &amp; Zeneca, Sanofi, MSD, Guigai, Astellas Inova Diagnostics, UCB Agnitio Science Technology, United Biopharma, Thermo Fisher, Consultant of: Pfizer, Novartis, Abbvie, Johnson &amp; Johnson, BMS, Roche, Lilly, GSK, Astra and Zeneca, Sanofi, Guigai, Astellas, Inova Diagnostics, UCB, Agnitio Science Technology, United Biopharma, Thermo Fisher, Gilead, Grant/research support from: Pfizer, Norvatis, BMS, Abbevie, Johnson &amp; Johnson, Roche,Sanofi, Guigai, Roche, Boehringer Ingelheim, UCB, MSD, Astra-Zeneca,Astellas, Gilead, Jiacai Cho: None declared, Aisha Lateef: None declared, Laniyati Hamijoyo Speakers bureau: from Pfizer, Novartis, Abbot, Shue Fen Luo: None declared, Yeong-Jian Jan Wu Speakers bureau: Pfizer, Lilly, Novartis, Abbvie, Sandra Navarra Speakers bureau: Pfizer, Johnson &amp; Johnson, Novartis, Astellas, Grant/research support from: Astellas, Johnson &amp; Johnson, Leonid Zamora: None declared, Zhanguo Li Speakers bureau: Eli Lilly, Novartis, GSK, AbbVie., Paid instructor for: Pfizer, Roche, Johnson, Consultant of: Eli Lilly, Pfizer, Grant/research support from: Pfizer, Yuan An: None declared, Sargunan Sockalingam Speakers bureau: Pfizer, Roche, Novartis, Grant/research support from: Roche and Novartis, Yasuhiro Katsumata Speakers bureau: YK has received honoraria from Chugai Pharmaceutical Co., Ltd., Glaxo-Smithkline K.K., and Sanofi K.K., Masayoshi Harigai Speakers bureau: MH has received speaker's fee from AbbVie Japan GK, Ayumi Pharmaceutical Co., Boehringer Ingelheim Japan, Inc.,Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., GlaxoSmithKline K.K., Kissei Pharmaceutical Co., Ltd., Pfizer Japan Inc., Takeda Pharmaceutical Co., Ltd., and Teijin Pharma Ltd., Consultant of: MH is a consultant for AbbVie, Boehringer-ingelheim, Bristol Myers Squibb Co., Kissei Pharmaceutical Co.,Ltd. and Teijin Pharma., Grant/research support from: MH has received research grants from AbbVie Japan GK, Asahi Kasei Corp., Astellas Pharma Inc., Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Daiichi-Sankyo, Inc.,Eisai Co., Ltd., Kissei Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Nippon Kayaku Co., Ltd., Sekiui Medical, Shionogi &amp; Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., and Teijin Pharma Ltd., Yanjie Hao: None declared, Zhuoli Zhang Speakers bureau: Norvatis, GSK, Pfizer, BMDB Basnayake: None declared, Madelynn Chan Speakers bureau: AbbVie, Novartis, Consultant of: Advisory Board member for Pfizer, Eli-Lilly, Jun Kikuchi: None declared, Tsutomu Takeuchi Speakers bureau: AbbVie AYUMI Pharmaceutical Corp. Bristol-Myers Squibb Chugai Pharmaceutical Co, Ltd. Daiichi Sankyo Co., Ltd. Eisai Co., Ltd. Eli Lilly Japan, Gilead Sciences, Inc. Mitsubishi-Tanabe Pharma Corp. Pfizer Japan Inc. Sanofi K.K., Consultant of: Astellas Pharma, Inc. Chugai Pharmaceutical Co, Ltd. Eli Lilly Japan, Mitsubishi-Tanabe Pharma Corp., Grant/research support from: AbbVie Asahikasei Pharma Corp. Chugai Pharmaceutical Co, Ltd. Mitsubishi-Tanabe Pharma Corp. Sanofi K.K., Sang-Cheol Bae: None declared, Shereen Oon: None declared, Sean O'Neill Consultant of: GSK, Fiona Goldblatt: None declared, Kathryn Gibson Speakers bureau: UCB, Consultant of: Novartis, Janssen Pharmaceuticals, Grant/research support from: Novartis, Employee of: Eli Lilly, Kristine Ng Speakers bureau: Abbvie, Novartis, Janssen, Annie Law: None declared, Nicola Tugnet: None declared, Sunil Kumar: None declared, Cherica Tee: None declared, Michael Tee: None declared, Yoshiya Tanaka Speakers bureau: Y. Tanaka has received speaking fees and/or honoraria from Daiichi-Sankyo, Eli Lilly, Novartis, YL Biologics, Bristol-Myers, Eisai, Chugai, Abbvie, Astellas, Pfizer, Sanofi, Asahi-kasei, GSK, Mitsubishi-Tanabe, Gilead, Janssen, Grant/research support from: Y. Tanaka, has received research grants from Abbvie, Mitsubishi-Tanabe, Chugai, Asahi-Kasei, Eisai, Takeda, Daiichi-Sankyo., C.S. Lau Shareholder of: Pfizer, Sanofi, and Janssen, Mandana Nikpour Speakers bureau: Actelion, GSK, Janssen, Pfizer, UCB, Paid instructor for: UCB, Consultant of: Actelion, Boehringer Ingelheim, Certa Therapeutics, Eli Lilly, GSK, Janssen, Pfizer, UCB, Grant/research support from: Actelion, Astra Zeneca, BMS, GSK, Janssen, UCB, Eric F. Morand Speakers bureau: AstraZeneca, Paid instructor for: Eli Lilly, Consultant of: AstraZeneca, Amgen, Biogen, BristolMyersSquibb, Eli Lilly, EMD Serono, Genentech, Janssen, Grant/research support from: AstraZeneca, BristolMyersSquibb, Eli Lilly, EMD Serono, Janssen, Alberta Hoi Consultant of: AH is on the advisory board for Abbvie and GSK, Grant/research support from: AH has received research support from AstraZeneca, GSK, BMS, Janssen, and Merck Serono.